In recent years, the rural hospital closure crisis has escalated with 2015 closure rates six times higher than in 2010. The National Rural Health Association (2020) reported that currently one in three rural hospitals may be at risk of closure. Much of the blame for closures has long been attributed to factors external to rural communities, such as reduced Medicare reimbursement, a declining rural economy, provider shortages, and being located in states that did not expand Medicaid under the Affordable Care Act. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. This chapter focuses on the Acceptability Scale.
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- Go to chapter: Achieving the Quadruple Aim in Healthcare With Evidence-Based Practice: A Necessary Leadership Strategy for Improving Quality, Safety, Patient Outcomes, and Cost Reductions
Achieving the Quadruple Aim in Healthcare With Evidence-Based Practice: A Necessary Leadership Strategy for Improving Quality, Safety, Patient Outcomes, and Cost Reductions
Evidence-based practice (
EBP) is a seven-step problem-solving approach to the delivery of healthcare that integrates the best evidence from well-designed studies with a clinician’s expertise and the values/preferences of the patient/family. This chapter discusses the importance of EBPin achieving the quadruple aim in healthcare, describes the current state of EBPin healthcare, including EBPcompetencies, identifies the barriers and facilitators of EBP, and discusses the key leadership strategies to ignite and sustain EBPin healthcare. It briefly describes EBPcompetencies for practicing registered nurses and advanced practice nurses in real-world clinical settings. Leaders must first understand that EBPis the direct pathway to achieve the quadruple aim in healthcare and be willing to invest in it knowing that healthcare quality and safety will be enhanced, population health outcomes will improve, healthcare costs will diminish, and clinician job satisfaction will increase as EBPdiffuses throughout the organization.
This chapter explores the use of virtual simulation from an administrative perspective. Nursing education is moving from PowerPoint lectures and technical skills laboratories on static body parts to engaged learning with high-fidelity simulation, learner-centered experiential teaching, and simulated and standardized patients, all of which help students learn to think, act, and reflect like nurses. Virtual simulation is one way of teaching and learning professional skills, assisting with the integration of acquired scientific knowledge, theory, and practice to promote clinical reasoning and critical thinking. The chapter explores ways in which administrators can support faculty and students while enhancing the educational experience at their institutions. It is important that administrators manage faculty and student expectations and needs while assessing university support for a variety of options; they must address the challenges and opportunities, and explore ideas for leveraging support by developing partnerships.
- Go to chapter: Administrative Perspective—Navigating the Chasm When a Profound Difference Exists Among Stakeholders, Viewpoints, and Feelings Regarding Virtual Simulation
Administrators must make a decisive, purposeful, realistic, and practical allocation of resources to lead and support the effort to adopt new, cost-effective, and learning enhancing instructional technologies. Nursing education administrators facilitate faculty development and active engagement in the area of virtual simulation and the use of technology in the teaching–learning process. The nurse administrator’s role is to ensure that technological systems are transformed effectively and that financial, ethical, and legal implications are considered. This chapter focuses on the positive aspects of the administrator’s roles as they relate to the integration of virtual simulation. The roles described provide a brief overview of the influence administrators can have on their institution’s technology plan, faculty’s willingness to engage in technology integration, and student learning. Visionary administrators are able to inspire, motivate, and support their faculty and students while paving the path to a smooth transition into virtual simulation integration.
One important goal of Healthy People 2020 is to improve the healthy development, health, safety, and well-being of both adolescents and young adults. Patterns of behavior during adolescence and young adulthood determine adult health status and health risks. While youth are generally healthy, it is important to assess and screen for issues that begin or peak during this developmental phase. These issues include mental health concerns, substance and tobacco/nicotine use, nutrition and weight concerns, sexually transmitted infections (
STIs) and HIV, unintended pregnancy, homelessness, academic issues, homicide and suicide, and accidents such as motor vehicle collisions.
- Go to chapter: Advanced Practice Nursing Roles and Competencies in Epidemiology and Population Health
Nurses play a key role in the field of epidemiology and in population health. Population-focused nursing demands application of nursing theory and practice while integrating the tenets of public health to contribute to the improvement of community and population health. While advanced practice nurses may not all specialize in public health, it is essential that advanced practice nurses have a foundational knowledge of concepts on the health and illness continuum from a population perspective. This chapter articulates the meaning of advanced practice nursing. It describes the role of the advanced practice nurse in epidemiology and population health. Consistent themes emerge across all functional roles of advanced practice nursing. Advanced assessment and analytic skills to include use of epidemiologic data and concepts to better understand disease occurrence and distribution are crucial to optimal health outcomes.
Advanced Practice Psychiatric Nursing, 3rd Edition:Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches Across the Life Span
Psychiatric-mental health advanced practice registered nurses (
PMH-APRNs) are like water: they are flexible, they are fluid, and they go where they are needed. Deinstitutionalization of psychiatric patients resulted in not only more community-based treatment, but also new and expanded outpatient roles for psychiatric nurses. The third edition of Advanced Practice Psychiatric Nursing meets the practice standards developed by the American Psychiatric Nurses Association, the International Society of Psychiatric-Mental Health Nurses, and the American Nurses Association, which require all PMH-APRNsto have skills in psychotherapy, psychopharmacology, and holistic assessment. Each chapter reflects not only state-of-the-art knowledge, but decades of clinical wisdom. The book is divided into five sections: Section I provides an overview of the theoretical and evidence base for practice and an exploration of the concept of shared decision-making and reaching concordance between clinicians and clients. Section II explores the foundations necessary for the practitioner to implement integrated practice and discusses the synergistic effects of integrating practice concepts. This includes chapters presenting the overviews of psychotherapy, psychopharmacology, and complementary and alternative approaches in the context of the stages of treatment. A new chapter focuses on legal and ethical issues in treatment. Section III applies the information from previous chapters and focuses on integrative management of specific syndromes. The chapters discuss mood disorders, anxiety-related disorders, psychotic symptoms, sleep disturbances, disordered eating, disordered cognition, impulse control, disordered attention, self-directed injury, and other-directed violence. Section IV covers aspects of managing substance misuse, medical problems, pregnancy, telehealth, and forensic issues that often co-occur with psychiatric syndromes. A new chapter focuses on care for sexual and gender minority patients. Section V covers the importance of maintaining competence and quality in clinical practice. The section includes a new chapter on self-care among PMH-APRNsthat focuses on resilience in practitioners, and the final chapter focuses on the global perspectives and the future of psychiatric-mental health advanced practice nursing.
- Go to chapter: Advancing Nursing Informatics Knowledge and Skills Using a Virtual Learning Environment
This chapter addresses the influence of the student role, especially in relation to students studying nursing informatics (NI). The NI student’s influence moves beyond the beginner roles and should be in the expert role. As students learn about NI, they also explore emerging technologies that provide opportunities for student-to-student collaboration. With the advent of virtual learning environments (VLEs) and virtual simulation, there is a greater need for faculty to develop informatics skills and competencies. The chapter provides a description of an educational process used to develop and deploy a program of simulation previously lacking in the graduate program and now used to improve NI skills and knowledge for both student and faculty. The foundations and framework for this project are based on needs and mandates identified by industry, healthcare, and professional organizations such as the American Nurses Association, Quality and Safety Education for Nurses Initiative, and National League for Nursing.
Aiming for impact means that one not only thinks that one can transform clinical service, but wants to develop and provide patients and their families with the kind of positive moments that are remembered 20 years later. Leadership presupposes aiming for impact; that is, a determination to address the challenges inherent in the current healthcare system. Impact means always giving some thought to how something good can be parlayed into something better. If one is aiming for impact, developmental learning will inevitably move from focusing on mastery of what today is considered to be best practice to imagining and developing a new and improved version of future practice. Nurses have historically been socialized in the direction of convergent thinking, but leadership requires divergent thinking, experiences that promote creativity and innovation.